does cultural competency make us in better delivering ... · cultural competency an anthropological...

“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE

POFPS 43RD Annual CME SymposiumAugust 3-5, 2018

Does Cultural Competency Make

Us in Better Delivering Patient Care

Devyani Chowdhury MD, DirectorLancaster, PA

#POFPS43

Disclosures


Dr. Chowdhury has provided no

disclosures.

#POFPS43

Lias Story


#POFPS43



Cultural Competency


#POFPS43

Cultural Competency


#POFPS43

Cultural Competency


Definition: The ability to interact

effectively with people of

different cultures, helps to ensure

the needs of all community

members are addressed.

#POFPS43



Cultural Competency

Does Cultural Competency

Make Us Better Delivering

Patient Care ?


#POFPS43

Cultural Competency


2 units:

1.Team giving Care

2.Team receiving care

#POFPS43

Cultural Competency


4 yr. old presents to the office

Accompanied by her mother who is

full burkha, does not speak english,

accompanied by a translator

#POFPS43



Cultural Competency

Audience question 1


#POFPS43

Cultural Competency

Is it important to spend time to understand the culture of this family?Will it impact the care?


#POFPS43

Cultural Competency

Amish familyBaby has dilated cardiomyopathy

No breast milkhome made goat milk based formula

No immunizations


#POFPS43



Cultural Competency

Audience question #2


#POFPS43

Cultural Competency

Would you discharge this patient from your practice?


#POFPS43

Cultural Competency

Report to CYSForce formula

Force immunization


#POFPS43



Cultural Competency

Health care literacy


#POFPS43

Cultural Competency

They are integrally related, along with preferred language.

Clinician can effectively and respectfully communicate with a patient if they do so in the patient's preferred language, in a way the patient can understand and act upon and one that takes the patient's cultural preferences into account.

Otherwise, it is likely that the patient will not follow through with the instructions and/or treatment plan….for several reasons as you may imagine.


#POFPS43

Cultural Competency

Does this create cultural

competency?


#POFPS43



Cultural Competency

When discussing culture I also include information on unconscious bias. I find it provides opportunities for the participants to pause, self-reflect and hopefully the "light bulb" will go off!

Especially for individual's that may have a potential comment as the one you shared.


#POFPS43

Cultural Competency

An anthropological approach to teach and evaluate cultural competence in medical

students – the application of mini-ethnography in medical history taking


Cultural Competency

Cultural competence is a crucial skill that helps health care providers to reduce

inequality in health care


#POFPS43



ACC’s Diversity and Inclusion Strategy: Working Toward a Diverse and Inclusive Cardiology Workforce

and Culture

#POFPS43

In comparison to the U.S. population, Adult cardiology is far less diverse…

• ACC 2016 Professional Life Survey suggests that African Americans and Hispanic each represent 3% to 6% of ACC membership

• <10% of medical students and less than 3% of SOM faculty are African American

• In 2015-2016, 5.4% of CV trainees were African American and 6.8% were Hispanic, compared to 5.8% and 7.8% respectively in internal medicine (ACGME)

CardiologyWhite/AsianAfrican AmericanHispanic

USA

White

African American

Hispanic

13%

17%5.0%

2.7%

#POFPS43

Trainees By Race/Ethnicity 2015-2016

0.0%

2.5%

5.0%

7.5%

10.0%

All residents GI Generalcardiology

EP General surgery Urology

Hispanic

ACGME GME Data Resource Book 2015-2016 Table c.23http://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book

AA

AA

Hisp

Hisp

African American

http://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book ACGME GME Data Resource Book 2015-2016 Table c.21

http://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book ACGME GME Data Resource Book 2015-2016 Table c.21



In comparison to U.S. medicine, Adult cardiology is far less diverse…

• In 2015, only 9.8% of FACCs who are U.S. board certified in adult CV are women

• About half of IM residents are women, compared with 21% of adult cardiology fellows. Even so, women are under represented in CV fellowships compared to almost every other specialty in the House of Medicine

• Review of ACC Awards indicates that 31 of 465 have gone to women (6.7%). Of these 10 went to pediatric cardiologists, 2 to statisticians, 1 to lay person, leaving <4% of ACC awards to adult CV women MDs.

USA Cardiology9.8%50.4%

#POFPS43

Adult CVD Board Certified Physicians:Distribution of Women

WY0%

12 states have <10 women CV MDs

SOURCE: ACC Database - June 2017

Prepared by: ACC Market Intelligence

CardiologyOctober 2017

#POFPS43



Diversity Plays an Important Role in the Nation’s Health

"The fact that the nation’s health professions have not kept pace with changing demographics may be an even greater cause of disparities in health access and outcomes than the persistent lack of health insurance for tens of millions of Americans."

Report of the Sullivan Report Commission on Diversity in the Healthcare Workforce: Missing Persons: Minorities In The Health Professions: A Report Of The Sullivan Commission On

Diversity In The Healthcare Workforce

Louis Sullivan, MD, ChairPast Secretary of US HHS

#POFPS43

Cultural Competency

Health care professionals cannot become culturally competent solely by readingtextbooks and listening to lectures.

They must be educated in environmentsthat are emblematic of the diverse society they will be called upon to serve


#POFPS43

Cultural Competency

“Stagnation in minority representation in the physician workforce

will have unwelcome consequences for the health of the nation.”


#POFPS43

http://www.aacn.nche.edu/media-relations/SullivanReport.pdf



Cultural Competency

Access for the underserved.

To provide improved access to high-quality health care for persons in our society who remain underserved.

Inadequate access to health care services remains a major problem within minority

populations.


#POFPS43

Cultural Competency

Broadened research agenda.

United States is plagued by unsolved health problems, many of which disproportionately affect minority populations


#POFPS43

Cultural Competency

Augment the pool of medicallytrained executives and public policymakers

available to assume management rolesin the future health care system and to

contribute to governmental efforts that addressimportant health care issues.


#POFPS43



Trends in Race/Ethnicity and Gender in Pediatrics

Diversity and Inclusion Task Force June, 2016

Data analysis and summary by

AAP Division of Health Services Research

#POFPS43

1.71.92.12.22.42.52.72.82.93.03.23.23.33.43.53.63.73.83.83.93.73.83.93.94.04.14.24.34.44.54.64.74.84.95.05.05.15.25.35.45.45.55.65.75.75.85.96.06.16.26.26.36.46.56.56.66.76.76.86.97.07.07.17.27.27.37.37.47.57.57.68.99.29.59.810.110.510.811.211.511.912.312.613.113.514.14.414.915.516.16.617.217.818.318.919.520.120.821.522.122.723.223.523.824.124.424.624.925.125.325.525.725.926.26.226.326.426.626.726.927.27.227.427.727.928.228.528.729.29.329.529.830.130.330.530.831.31.231.431.631.831.9

14.514.614.614.614.614.614.614.614.714.714.714.915.15.115.215.315.315.415.415.514.814.814.814.714.614.514.514.414.314.214.114.13.913.813.813.713.713.613.613.513.513.513.513.513.513.513.513.513.513.413.413.413.413.413.413.413.313.313.313.313.213.213.213.213.213.113.113.113.113.113.1

74.073.472.972.472.071.571.070.569.969.368.968.267.666.966.365.765.164.463.762.961.260.459.758.958.257.456.655.855.054.353.753.252.852.351.951.651.350.950.550.249.849.549.148.848.548.247.947.647.346.946.646.245.845.445.044.644.243.743.342.942.542.141.741.340.940.640.239.839.539.238.8

0.

20.

40.

60.

80.

1980 1990 2000 2010 2020 2030 2040 2050

% o

f Po

pu

lati

on

Non-Hispanic Asian Hispanic Non-Hispanic Black Non-Hispanic White

Projected (2015-2050)

Source: U.S. Census Bureau (http://www.childstats.gov/americaschildren/tables/pop3.asp)

Trends in Race/Ethnicity of U.S. Children (under 18), Recorded (1980-2014) and Projected (2015-2050)

#POFPS43

0

17500

35000

52500

70000

87500

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

Nu

mb

er o

f R

esid

ents

White Asian

Hispanic Black

58%

28%

8%

6%

Source: Graduate Medical Education, Brotherton & Etzel, JAMA, 2006 through 2015

All Residents in ACGME-Accredited Programs: Race and Ethnicity

#POFPS43

http://www.childstats.gov/americaschildren/tables/pop3.asp



0

1500

3000

4500

6000

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

Nu

mb

er o

f R

esid

ents

White Asian

Hispanic Black


62%

23%

6%

9%

Pediatric Residents in ACGME-Accredited Programs: Race and Ethnicity

#POFPS43

-0.8

6.5

13.8

21.

28.3

35.5

42.8

50.

2006

2007

2008

2009

2010

2011

2012

2013

20

14

2015

Per

cen

tage

of

IMG

Res

iden

ts

All Docs Pediatrics


International Medical Graduates in Residency Programs 2006-2015

#POFPS43

2.1 2.6 2.9 3.6 4.15. 4.2 4.14.6 4.9 4.1 4.7 5.6

4. 4.8 5.3

12.9 12.814.8 14.8

16.7 15.8 15.4 15.2

0.

5.

10.

15.

20.

25.

Black Hispanic Asian

Race/Ethnicity of Pediatricians by Year (Including Residents)

% o

f P

ed

iatr

icia

ns

Source: AAP Periodic Survey 1990-2013

1990-92 1993-95 1996-98 1999-01 2002-04 2005-07 2008-10 2011-13

#POFPS43



Conclusions: Race and Ethnicity

• Increase in the racial/ethnic diversity of children

• No change in the racial/ethnic diversity of pediatricians

• Similar to medicine overall

• Major leak in diversity pipeline between start of high school and end of college

• IMGs provide a source of increased diversity

#POFPS43

Cultural Competency

Understanding patients' diverse cultures — their values, traditions, history and institutions — is not simply political correctness. It is integral to

eliminating health care disparities and providing high-quality patient care. Culture shapes individuals' experiences, perceptions, decisions and how they relate to others. It influences the way patients respond to medical services and preventive interventions and impacts the way physicians deliver those services. In a society as culturally diverse as the United States, physicians and others in health care delivery need sensitivity toward diverse patient

populations and work to understand culturally influenced health behaviors.


#POFPS43

Cultural Competency

Self test for cultural competency


#POFPS43



Cultural Competency


#POFPS43


#POFPS43

Cultural Competency


#POFPS43



Cultural Competency


#POFPS43

Cultural Competency


#POFPS43


#POFPS43

does cultural competency make us in better delivering ... · cultural competency an anthropological...

Documents